Autonomic drugs (FA pg 249 - 256)

Question 1

bethanoechol

Answer 1

• cholinomimetic (direct agonist)
• for postoperative ileus, neurogenic ileus, urinary retention
• activates bowel and bladder smooth muscle

Question 2

carbachol

Answer 2

• cholinomimetic
• constricts pupil, relieves intraocular pressure in glaucoma
• “carbon copy of acetylcholine”

Question 3

methacholine

Answer 3

• cholinomimetic
• challenge test for asthma dx
• stimulates muscarinic receptors in airway

Question 4

pilocarpine

Answer 4

• cholinomimetic
• potent stimulator of sweat, tears, saliva. open-agle and closed-angle glaucoma
• contracts ciliary muscle of eye, pupillary sphincer

Question 5

donepezil, galantamine, rivastigmine

Answer 5

• anticholinesterase
• alzheimers
• increase ACh

Question 6

edrophonium

Answer 6

• anticholinesterase
• historically, dx MG (short acting)
• increases ACh

Question 7

neostigmine

Answer 7

• anticholinesterase
• postoperative and neurogenic ileus, urinary retention, MG, reversal of NM junction blockade
• increase ACh
• no CNS penetration

Question 8

physostigmine

Answer 8

• anticholinesterase
• anticholinergic toxicity (atropine overdose)
• increase ACh

Question 9

pyridostgmine

Answer 9

• anticholinesterase
• MG (long acting)
• increase ACh

Question 10

atropine

Answer 10

• muscarinic antagonist
• heart: bradycardia
• eye: mydriasis, cycloplegia
• airway: decrease secretions
• stomach: decrease acid secretion
• gut: decrease motility
• bladder: increase urgency in cystitis

Question 11

benztropine

Answer 11

• muscarinc antagonist
• parkinson
• “park my benz”
• also treats acute dystonia

Question 12

glycopyrrolate

Answer 12

• muscarinic antagonist
• reduce airway secretions
• treats drooling, peptic ulcer

Question 13

hyoscyamine, dicyclomine

Answer 13

• muscarinic antagonist

- antispasmotic for IBS

Question 14

ipratropium, tiotropium

Answer 14

• muscarinic antagonist

- COPD, asthma

Question 15

oxybutynin, solfenacin, tolterodine

Answer 15

• muscarinic antagonist

- reduce bladder spasms, urge urinary incontinence

Question 16

scopolamine

Answer 16

• muscarinic antagonist

- motion sickness

Question 17

albuterol, salmeterol

Answer 17

• direct sympathomimetic
• B2 > B1
• albuterol: acute asthma
• salmeterol: long term asthma, COPD

Question 18

dobutamine

Answer 18

-direct sympathomimetic
B1 > B2, a
-HF (inotropic > chronotropic)
-cardiac stress test

Question 19

dopamine

Answer 19

• direct sympathomimetic
• D1 = D2 > B > a
• unstable bradycard
• HF, shock,
• inoptropic and chrono a effecs predominate at high doses

Question 20

epinephrine

Answer 20

• direct sympathomimetic
• B > a
• anaphylaxis, asthma, open-angle glaucoma
• a effects predominate at high doses
• much stronger B2 effect than norepi

Question 21

isoproterenol

Answer 21

• direct sympathomimetic
• B1 = B2
• electrophysiological eval of tachyarrhythmias
• can worsen ischemia

Question 22

norepi

Answer 22

• direct sympathomimetic
• a1 > a2 > B1
• hypotension (but decreases renal perfusion)
• significantly weaker effect at B2 than epi

Question 23

phenylephrine

Answer 23

• direct sympathomimetic
• a1 > a2
• hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

Question 24

amphetamine

Answer 24

• indirect sympathomimetic
• indirect agonist, reuptake inhibitor, also releases stored catecholamines
• narcolepsy, obesity, ADHD

Question 25

cocaine

Answer 25

- indirect sympathomimetic - indirect agonist, reuptake inhibitor - local vasoconstriction and anesthesia - ! Never give B-blockers if cocaine intox is suspected --> can lead to unopposed a1 activation --> extreme HYPERtension!

Question 26

ephedrine

Answer 26

- indirect sympathomimetic - indirect agonist, releases stored catecholamines - nasal decongestion, urinary incontinence, hypotension

Question 27

clonidine

Answer 27

- a2 agonist - for hypertensive urgency (does not decrease renal blood flow), ADHD, Tourette - tox: cns depression, hypotension ,respiratory depression, miosis

Question 28

a-methyldopa

Answer 28

- a2 agonist - for hypertension in pregnancy - toxicity: direct Coombs +, hemolysis, SLE-like syndrome

Question 29

phenoxybenzamine

Answer 29

- non-selective a-blocker (irreversible) - for pheochromocytoma (preoperatively) to prevent catecholamine (HTN) crisis - tox: orthostatic hypotension, reflex tachycardia

Question 30

phentolamine

Answer 30

- non-selective a-blocker (reversible) - given to patients on MAO-I who eat tyramine-containing food - tox: orthostatic hypotension, reflex tachycardia

Question 31

prazosin, terazosin, doxazosin, tamsulosin

Answer 31

- a-1 selective blocker - for BPH - tox: orthostatic hypotension, dizziness, HA

Question 32

mirtazapine

Answer 32

- a-2 selective blocker - for depression - tox: sedation, increase serum cholesterol, inc. appetite

Question 33

B-blocker selectivity rules

Answer 33

B-1 selective: start with A - M | nonselective: nadolol, pindolol (partial agonist), propranolol, timolol: start with N - Z